Post-Cholecystectomy Biliary Leak and Its Management in a Tertiary Care Hospital of Lahore City: A Cross Sectional, Descriptive Study

Abstract

Abstract
Background and Objective: Leakage of bile after open or laparoscopic cholecystecmy israre, but if occurred,
is associated with higher risk of morbidity and mortality. The objective of this study was to describe the
experience of managing post-cholecystectomy biliary leak in a tertiary care hospital of Lahore, Pakistan.
Methods: In this descriptive, cross sectional study, twenty-two cases were included using purposive sampling
technique. These cases presented with bile leakage after cholecystectomy (open and/or laparoscopic) over the
period of 3.5 years in a surgical unit. The patients were managed on case-to-case basis using a standardized
revised algorithm. All patients were managed by ultrasonography guided drainage, and laparoscopic wash
with control of sepsis. Magnetic Resonance cholangiopancreatography (MRCP) was conducted to classify
injury using Strasberg's classification and managed according to the injury type. Data were managed and
analyzed using SPSS version 25 and described using frequency and percentages.
Results: Cases were aged between 30-60 years and out of 22 patients, twelve presented with bile leaks
through drain left in-situ (55%), six presented with peritonitis with drain in-situ (27%), four patients (18%)
had abdominal distension and peritonitis. Firty-one percent patients were managed by ultrasound guided
drainage and in 9/22 patients laparoscopic wash and drain placement was done. In six patients, ERCP with
stent was used. In 5/22 patients, hepaticojejunostomies were performed.
Conclusion: Post-cholecystectomy iatrogenic biliary leak can be managed by drain placement, abdominal
wash and antibiotics. Presented algorithm will help surgeons to manage post-cholecystectomy biliary leak
effectively with low risk of mortality and morbidity.
Keywords: Bile duct disease, post-operative complications, Common bile duct injuries, Biliary fistula ,
fistula biliary, biliary leakage, Cholecystectomy